NPIMap

Organization Active NPI

Msocs-Chatham

  • Intellectual Disabilities Intermediate Care Facility
  • Eden Prairie, MN
National Provider Identifier
1720151897
Registry record updated Jun 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
MSOCS-CHATHAM
Practice address
6204 Chatham Way
Eden Prairie, MN 55346-1307
Phone
(952) 934-0995
NPI assigned
Nov 16, 2006
Organization subpart
Yes
Parent organization
EASTERN MINNESOTA STATE OPERATED COMMUNITY SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 18, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Roger A Deneen
Title
Residential Prog SVCS Director
Phone
(651) 582-1857

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

6204 Chatham Way
Eden Prairie, MN 55346-1307

Mailing address

PO Box 64979
Saint Paul, MN 55164-0979

Other identifiers 1

IdentifierTypeStateIssuer
064245200MedicaidMN

National Provider Directory

National Provider Directory
Tax ID family
Msocs-Shumway14 organizations share this tax ID, including this one
Part of
Msocs-Shumway

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1720151897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64979",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551640979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6204 CHATHAM WAY",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553461307",
            "telephone_number": "952-934-0995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MSOCS-CHATHAM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EASTERN MINNESOTA STATE OPERATED COMMUNITY SERVICES",
        "enumeration_date": "2006-11-16",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "DENEEN",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "RESIDENTIAL PROG SVCS DIRECTOR",
        "authorized_official_telephone_number": "651-582-1857"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "064245200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eden Prairie, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.